{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:49:33Z","timestamp":1753876173061,"version":"3.41.2"},"reference-count":14,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2024,1,30]],"date-time":"2024-01-30T00:00:00Z","timestamp":1706572800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Mitral regurgitation (MR) in the context of left ventricular systolic dysfunction is often designated as functional, with emphasis on the underlying cardiomyopathy leading to malcoaptation of the \u2018otherwise normal valve\u2019.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A 63-year-old male with ischaemic cardiomyopathy (left ventricular ejection fraction 20%) presented with intractable heart failure in need of inotropic support and could not be stepped down from an ICU hospital setting. Functional MR, graded as moderate on transthoracic echocardiography, was initially not considered as pertinent to the clinical condition and options discussed included initiation of dialysis for volume management, chronic inotropic support, and palliative measures. However, a re-examination of the mitral valve by transoesophageal echo revealed severe regurgitation from annular dilatation and restricted mobility during systole. Transcatheter edge to edge repair utilizing the PASCAL device resulted in marked reduction of MR followed by an abrupt clinical improvement, weaning off inotropes and discharge home 4 days later. At four-year follow-up, the patient is stable on optimal heart failure therapy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>For many patients with heart failure and underlying cardiomyopathy, the presence of significant functional MR, instead of a \u2018bystander\u2019 disease, actually becomes the dominant driver of symptoms and compounds the low cardiac output state. In these patients, the term \u2018functional\u2019 MR becomes a misnomer, as in fact the so called \u2018otherwise normal\u2019 mitral valve is actually a severely dysfunctional valve with a wide malcoaptation zone. Transcatheter edge to edge repair is an effective bailout procedure for patients with low cardiac output and disproportionate severe functional MR.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytae041","type":"journal-article","created":{"date-parts":[[2024,1,30]],"date-time":"2024-01-30T17:40:45Z","timestamp":1706636445000},"source":"Crossref","is-referenced-by-count":0,"title":["Severe functional ischaemic mitral regurgitation: is functional a misnomer for a dysfunctional valve? A case report"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5399-1309","authenticated-orcid":false,"given":"Michael P","family":"Chrissoheris","sequence":"first","affiliation":[{"name":"Department of Transcatheter Heart Valves, Hygeia Hospital , 9 Erythrou Stavrou Street , Marousi, TK 15123 Attiki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Panagiota","family":"Kourkoveli","sequence":"additional","affiliation":[{"name":"Department of Transcatheter Heart Valves, Hygeia Hospital , 9 Erythrou Stavrou Street , Marousi, TK 15123 Attiki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dionysios","family":"Aravantinos","sequence":"additional","affiliation":[{"name":"Department of Transcatheter Heart Valves, Hygeia Hospital , 9 Erythrou Stavrou Street , Marousi, TK 15123 Attiki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konstantinos","family":"Spargias","sequence":"additional","affiliation":[{"name":"Department of Transcatheter Heart Valves, Hygeia Hospital , 9 Erythrou Stavrou Street , Marousi, TK 15123 Attiki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,1,30]]},"reference":[{"key":"2024022817004302800_ytae041-B1","doi-asserted-by":"crossref","first-page":"1759","DOI":"10.1161\/01.CIR.103.13.1759","article-title":"Ischemic mitral regurgitation: long-term outcome and prognostic implications with quantitative Doppler assessment","volume":"103","author":"Grigioni","year":"2001","journal-title":"Circulation"},{"key":"2024022817004302800_ytae041-B2","first-page":"1675","article-title":"Independent prognostic value of functional mitral regurgitation in patients with heart failure. 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